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Saudi Journal of Kidney Diseases and Transplantation
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   2009| January-February  | Volume 20 | Issue 1  
    Online since December 27, 2008

 
 
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RENAL DATA FROM THE ARAB WORLD
Empirical treatment for pediatric urinary tract infection and resistance patterns of uropathogens, in Queen Alia hospital and prince A'Isha military center - Jordan
Reham Issa Al-Mardeni, Adel Batarseh, Lina Omaish, Majdolin Shraideh, Basma Batarseh, Nidal Unis
January-February 2009, 20(1):135-139
PMID:19112236
We conducted this retrospective study to identify the most appropriate oral antibiotic as empiric treatment of urinary tract infection according to resistance patterns of uropathogens among children treated at Queen Alia Military Hospital and Prince A`isha Bent Al-Hussein Military Center from January 2006 to April 2007. Urine cultures for isolated microorganism and their anti­biotic susceptibility in patients below the age of 14 years treated as outpatient were reviewed. Out of 3820 cultures, 529 isolates were found, E coli was the most frequent organism. Resistance to Ampicillin, sulfamethoxazole, and trimethoprim (TMP-SMZ) was common, and multidrug-resistant (MDR) among E. coli isolates was 59.9%. Knowledge of patterns of resistance at each institution helps in deciding empiric therapy for UTI. Pretreatment urine culture should be performed and followed up for the continuation of the treatment.
  11 8,818 1,100
CASE REPORTS
Severe rhabdomyolysis and acute renal failure secondary to use of simvastatin in undiagnosed hypothyroidism
Faiza A Qari
January-February 2009, 20(1):127-129
PMID:19112232
A 52-year-old Indian woman with underlying diabetes mellitus and hyperlipidemia, presented with generalized musculoskeletal pain and oliguria for three days. The patient was taking 80 mg of simvastatin initiated 20 days earlier after cardiac catheterization for an inferior myocardial infarction. Laboratory investigations revealed the following serum levels: creatine kinase 81,620 U/L, aspartate aminotransferase 2497 U/L, alanine aminotransferase 1304 U/L, blood urea nitrogen 21.7 mmol/L, creatinine 447 µmol/L, Free T4 12.6 pmol/L, and thyroid stimulating hormone (TSH) 22.7 µIU/L. Simvastatin was discontinued and the patient received forced alkaline diuresis. Her hypo thyroidism was treated with thyroxin, which was continued upon discharge, and her renal function recovered within two months. This case report discusses the incidence of rhabdomyolysis in a patient with primary hypothyroidism receiving large doses of simvastatin.
  8 3,648 771
ORIGINAL ARTICLES
Microvascular and macrovascular complications in diabetic nephropathy patients referred to nephrology clinic
Jamal S Al-Wakeel, Durdana Hammad, Abdulkaraem Al Suwaida, AH Mitwalli, Nawaz Ali Memon, Fathia Sulimani
January-February 2009, 20(1):77-85
PMID:19112222
To evaluate the diabetic complications and fate of diabetic nephropathy in Saudi population, we studied 184 diabetic nephropathy (DN) patients who were referred to nephrology clinic of King Khalid University Hospital, Riyadh, Saudi Arabia from January 2003-June 2006. The patients had mean age of 61.9 ± 13.1 years, included 128 (69.6%) males, and were followed up for a mean period of 10.2 ± 1.5 years. The mean duration of diabetes mellitus (DM) was 19.5 ± 5.8 years, and duration of nephropathy was 7.7 ± 3.3 years. Family history of DN was documented in 52 (28.2%) patients. At initial visit, the mean systolic blood pressure was 164 ± 14.5 mmHg, the mean diastolic blood pressure was 97.9 ± 10.4 mmHg. Thirty­seven (20%) patients had normal BMI, 88 (48%) were overweight, while 55 (30%) were obese. Mean creatinine clearance was 51.7 ± 26.3 mL/min, 24 hrs urinary proteins 1.99 ± 2.48 gm/day, HbA1C 9.2 ± 1.8 %, triglyceride 2.1 ± 1.3 mmol/L, and cholesterol 5.17 ± 1.54 mmol/L. Diabetic complications included angiography proven coronary artery disease in 106 (57.6 %) patients, stroke in 21 (11.4%), myocardial infarction (MI) in 27(14.6%), angina in 87 (47.2 %), retinopathy in 82 (44.5%), Blindness in 3 (1.6%), peripheral vascular disease in 121 (65.7%), Neuropathy in 123 (66.8%), hypertension in178 (96.7%), diabetic foot in 25 (13.5%), Amputation in 10 (5.4%), and end-stage renal disease in 70 (38%). Total of 13 (7.05%) patients died in the hospital. Thirty-seven percent of patients developed > 6 concomitant complications. 28% developed 5, 17% developed 4, and the rest developed < 3. DN was relatively refractory to therapy and progressive; 123 (66.8%) patients doubled their serum creatinine in 3.59 ± 2.88 years, 32 (17.3%) maintained stable renal function, 136 (73.6 %) deteriorated, and 12 (6.52%) improved. we conclude that the prevalence of diabetic complications is high among Saudi patients, and many had multiple complications. Baseline creatinine clearance and proteinuria, high systolic blood pressure, advanced age, and longer duration of diabetes were the most significant risk factors for developing complications.
  8 6,227 1,286
Oral lesions in Saudi renal transplant patients
Maha Ali Al-Mohaya, Azmi Mohammad-Ghaleb Darwazeh, Salih Bin-Salih, Waleed Al-Khudair
January-February 2009, 20(1):20-29
PMID:19112215
Renal transplantation has evolved as the best treatment option for patients with end­stage renal disease. Different oral problems arise in these patients, either as a direct consequence of drug-induced immunosuppression or pharmacokinetics. To determine the prevalence of intra-oral lesions in a group of medically stable Saudi renal transplant patients (RTP) and to identify possible risk factors, in comparison with age and sex-matched healthy control subjects (HCS), we studied 58 RTP and 52 HCS. All subjects had a thorough oral examination and oral lesions were diagnosed according to the clinically accepted criteria. Gingival overgrowth (GO), erythematous candidiasis (EC) and hairy leukoplakia (HL) were diagnosed in RTP with prevalence of 74.1%, 15.5%, and 8.6%, respectively. The severity of the gingival overgrowth significantly correlated with the use of cyclosporine and nifedipine combination therapy, serum cyclosporine, and serum creatinine level. In conclusions, the finding of our study strongly propose that RTP should undergo routine and regular comprehensive oral examination, and any suspicious lesion must be investigate and treated.
  7 5,149 1,956
RENAL DATA FROM THE ARAB WORLD
Epidemiology of hemodialysis patients in Aleppo city
Ghamez Moukeh, Rabi Yacoub, Fadi Fahdi, Samer Rastam, Sami Albitar
January-February 2009, 20(1):140-146
PMID:19112237
To determine the characteristics of the hemodialysis (HD) patients in Aleppo city, we surveyed the hospitals representing the main dialysis centers in the city including private and community facilities during 2006. Personal patients' interviews and hospitals records were the source of data. The total number of patients in 2006 undergoing HD was 550 patients; 280 (50.9%) were males, and the age ranged from 5-82 years with mean and median age 44.7 and 45 years, respectively. The incidence (IR) and prevalence rate (PR) for hemodialysis were 60 pmp and 226 pmp, respectively. The major primary renal diseases in the end-stage renal disease (ESRD) patients included hypertension (HTN), glomerulonephritis (GN), and diabetes mellitus (DM), 21.1%, 20.5 %, and 19.45, respectively. The percent of Anti-HCV, HBV hepatitis and HBV vaccine were 54.4%, 7.8%, and 52.9%, respectively. This study suggests that the IR of hemodialysis was relatively low due to the high cost of treatment, and the PR for hemodialysis was also relatively low may be due to high mortality rate and low kidney transplantation rate in this country. There was an equal percentage of both genders in the hemodialysis population.
  7 2,897 600
RENAL DATA FROM THE ASIA - AFRICA
Hepatitis C virus infection among patients on hemodialysis: A report from a single center in Iran
Eghlim Nemati, Seyed Moayed Alavian, Saeed Taheri, Mehran Moradi, Vahid Pourfarziani, Behzad Einollahi
January-February 2009, 20(1):147-153
PMID:19112238
The aim of this study is to evaluate the incidence of hepatitis C virus (HCV) infec­tion among the hemodialysis (HD) patients at the Nephrology and Urology Research Center, Tehran, Iran, and identify the potential risk factors. A total of 112 patients on HD in our two dia­lysis units were studied. The mean duration of follow-up was 27 ± 27 months (range, 6-132). All study subjects were HCV-negative at entry to the study and were tested for anti-HCV antibody by ELISA II every six months thereafter. Positive samples were re-examined by RT/PCR for confir­mation. Factors that might be implicated in HCV transmission were evaluated. Six patients (5.3%) were labeled as HCV infected, at the end of the follow-up period. Thus, the incidence of HCV infection in our dialysis units was 1.8 per 100 person years. A total of 64.5% of the study popu­lation had previous history of blood transfusion(s) and 8% had undergone prior transplantation. Univariate analysis showed a significant relationship between number of blood transfusions and duration on dialysis and HCV infection. Multivariate analysis revealed that only duration on HD was significantly associated with HCV positivity (OR: 1.03, p=0.008). Our study further suggests that nosocomial transmission plays a major role in HCV transmission among patients on HD. Meticulous practice of preventive measures is essential to eradicate the spread of HCV in HD units.
  7 3,349 644
The islamic perspective of organ donation in Pakistan
Muhammad Ilyas, Mukhtar Alam, Habib Ahmad
January-February 2009, 20(1):154-156
PMID:19112239
  7 9,455 1,021
CASE REPORTS
Selenium intoxication with selenite broth resulting in acute renal failure and severe gastritis
P Kamble, N Mohsin, A Jha, A Date, A Upadhaya, E Mohammad, M Khalil, A Pakkyara, M Budruddin
January-February 2009, 20(1):106-111
PMID:19112227
Selenium (Se) is an essential trace element in human and animal nutrition. It is also widely utilized in industrial processes. Reports of acute selenium toxicity in humans are rare. We report a case of a 23-year-old female who consumed about 100 mL of liquid selenite broth and presented with severe nausea, vomiting, abdominal pain, hematemesis and acute renal failure (ARF). The serum selenium level was significantly increased. Gastro-duodenoscopy revealed severe corrosive gastritis. Renal biopsy showed features of acute tubular necrosis (ATN), affecting primarily the proximal tubules. The patient was managed with gastric lavage, blood transfusions, infusion of fresh frozen plasma (FFP) and platelet concentrates and hemo­dialysis. The patient was discharged five weeks after admission and her renal functions reco­vered completely by eight weeks after admission. She continues to be on regular follow-up for any possible sequelae of mucosal corrosive damage. This case highlights a case of selenium intoxication from selenite broth resulting in ARF and corrosive gastritis. The recovery was complete.
  3 5,520 736
EDITORIALS
Role of bone biopsy in renal osteodystrophy
Wisam Al Badr, Kevin J Martin
January-February 2009, 20(1):12-19
PMID:19112214
Renal osteodystrophy (ROD), the abnormal bone histology that occurs in the context of kidney disease, is a disease spectrum and not a uniform progressive bone disease. It is an important component of the broad disturbances of bone and mineral metabolism associated with chronic kidney disease (CKD). There are multiple pathogenetic factors which contribute to the histological abnormalities seen on bone biopsy. The patients with ROD are rarely symp­tomatic in the early stages of CKD. It is also noteworthy that the clinical manifestations are usually preceded by biochemical changes that are insidious and subtle. This makes it difficult for the clinician to suspect the presence of bone and mineral metabolism abnormalities without direct testing. The serum calcium, phosphorus, and alkaline phosphatase levels are usually normal until late in the course of CKD. The main screening test for abnormal bone and mineral metabolism is the measurement of parathyroid hormone which is also somewhat delayed. The clinical signs and symptoms are also challenging to interpret because of their slow and non-specific nature which may include vague, ill-defined, bone aches and pains, and muscle weakness. The gold standard for diagnosis of ROD is bone biopsy with mineralized bone histology after double tetracycline labeling, iron staining and aluminum staining. The currently used histomorphometric descriptions of bone histology are not well integrated clinically and a new nomenclature that is clinically more relevant and useful has been proposed. Additional studies are required to define the spectrum of ROD in the current therapeutic era, and to find clinically useful non-invasive biomarkers to improve the treatment and monitoring of the abnormal bone in the setting of CKD.
  3 4,062 1,807
ORIGINAL ARTICLES
Value of color doppler sonography in the assessment of hemodialysis access dysfunction
Khaled M Moghazy
January-February 2009, 20(1):35-43
PMID:19112217
Arteriovenous fistula (AVF) is the most widely used means of vascular access for long-term hemodialysis (HD) and the complication rate related to AVF remains high. This study was conducted to determine the efficiency of Color Doppler sonography (CDS) in the assessment of AVF dysfunction. Over a period of 29 months, from January 2005 to May 2007, a total of 55 patients with AVF access dysfunction were included in the study. CDS were performed in the King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. CDS allowed identification of 23 patients with stenotic segments and 16 others with venous thromboses. Six patients with venous aneurysm were encountered. Doppler flow rate assessment allowed differentiation of venous hypertension in two patients and steal syndrome in two other patients. Thus, the CDS findings carried a sensitivity rate of 96.4%. Two subclavian vein stenoses, causing reduced blood flow rate, were missed by CDS and later confirmed by angiography. Thirty-four patients underwent operative intervention. Our study suggests that CDS is an ideal noninvasive technique that allows the assessment of both anatomy and hemodynamics of an AVF.
  3 6,985 1,362
Acute renal failure in pediatric patients: Etiology and predictors of outcome
Amal Abdel Ghani, Bassam Al Helal, Naser Hussain
January-February 2009, 20(1):69-76
PMID:19112221
Acute renal failure (ARF) is the acute loss of kidney function over hours or days, the etiology of which varies in different countries. The data on the etiology and outcome of ARF in Arab children is limited. Our objective was to define the causes and predictors of outcome of ARF in Kuwaiti children, and the variables determining their fitness for dialysis. A total of 32 children with ARF were evaluated regarding their demographic and clinical data, the cause of ARF and the co-morbidities. Data were analyzed to find the independent variables determining fitness for dia­lysis and outcome. Males comprised 62.5% of the study children; 46.9% of ARF cases were due to sepsis and 56.2% underwent renal replacement therapy (RRT). Univariate analysis showed that age, hemodynamic instability, use of vasopressors, multi-organ failure (MOF), and mechanical venti­lation contributed to fitness for dialysis. However, MOF was the only independent variable affecting fitness for dialysis. The overall mortality was 43.8%. Univariate analysis showed that age below 24-months, hemodynamic instability, use of vasopressors, fluid overload, need for mecha­nical ventilation, MOF and late referral to the nephrologist were associated with poor outcome. However, multivariate analysis documented MOF, and the time of nephrologists' intervention as independent prognostic indicators. Our study suggests that sepsis was the major cause of pediatric ARF. RRT is the optimal treatment, and the only factor determining child's fitness for dialysis is MOF.
  3 12,105 1,497
CASE REPORTS
Reflex anuria affecting both kidneys following hysterectomy
Mahmoud Gholyaf, Saeed Afzali, Hoshang Babolhavaegi, Abolfazl Rahimi, Seyed A Wagharseyedayn
January-February 2009, 20(1):120-123
PMID:19112230
In situations when there is unilateral ureteral obstruction, the contralateral kidney retains its normal function. In rare instances however, it has been reported that unilateral ureteral obstruction can lead to reflex anuria (RA) and acute renal failure (ARF). Even more unusually, RA with ARF can occur without organic obstruction due to ureteric manipulation during pelvic surgery. We report a 78- year-old woman, who underwent hysterectomy because of endometrial carcinoma. She developed ARF evidenced by anuria of 120-hours duration, and gradual rise of serum creatinine levels to 11.8 mg/dL on the fifth day after hysterectomy. Ultrasound study of the urinary tract revealed bilateral moderate hydronephrosis. Detailed evaluation did not reveal any organic obstruc­tion. She was managed with hemodialysis, control of hypertension and correction of fluid and elec­trolyte imbalances. By the sixth day, diuresis was established, and the blood urea and serum crea­tinine levels decreased to normal by the sixteenth day. The patient was finally discharged on the eighteenth day. Our case suggests that urologists and nephrologists should consider RA as one of the causes of anuria and ARF.
  2 4,394 501
EDITORIALS
Short daily and nocturnal hemodialysis: New therapies for a new century?
Micheal V Rocco
January-February 2009, 20(1):1-11
PMID:19112213
The National Institutes of Health (NIH) sponsored HEMO Study did not demonstrate that an increase in dialysis dose was associated with an improvement in patient mortality rates. Despite this negative result, there is ongoing interest in determining if still higher doses of dialysis may be of benefit to patients receiving chronic hemodialysis therapy. Testing this hypothesis requires the use of more fre­quent hemodialysis and/or a much longer duration for each dialysis session. "Short daily hemodialysis", actually six times per week hemodialysis for 1.5 to 3 hours per session, provides a significant increase in small molecule clearance as measured by urea kinetics. "Long nocturnal daily hemodialysis", actually six times per week hemodialysis for 6-8 hours per session, provides a significant increase in both small and large molecular weight clearance and often alleviates the need to take phosphate binders. Both forms of more frequent dialysis have been shown to improve control of blood pressure. One small randomized trial of nocturnal versus conventional home dialysis showed a decrease in left ventricular (LV) mass at 6 months in the nocturnal arm only. Most clinical trials conducted in these dialysis modalities have been observational trials and have enrolled small numbers of patients. The National Institutes of Health is sponsoring two clinical trials via the Frequent Hemodialysis Network to determine the effect of these two more frequent dialysis modalities on intermediate outcomes. In the short daily study, 250 patients will be randomized to receive either six times per week HD, with a session length of 1.5 to 2.75 hours, or conventional in-center hemodialysis. In the nocturnal study, 150 patients will be randomized to receive either six times per week overnight dialysis, with a session length of at least 6 hours, or conventional home hemodialysis.
  2 5,456 2,261
ORIGINAL ARTICLES
Renal involvement in children with spina bifida
Jameela A Kari, Osama Safdar, Roaa Jamjoom, Wasim Anshasi
January-February 2009, 20(1):102-105
PMID:19112226
Renal scarring and renal failure remain life-threatening for children born with spinal dysraphism. An early start of therapy helps to safeguard renal function for such children and avoid end-stage renal disease. However, optimal care is not always available in developing countries. We reviewed our data on all newborns with spina bifida who were born at King Abdulaziz University Hospital between 1997 and 2006. Thirty-three children with myelomeningocele (MMC) were eva­luated; MMC site was thoracolumbar in 26 patients (77.1%) and in the lumbosacral area in 7 patients (22.9%). The mean age at the time of evaluation was 5.4 ± 2.3 years. Thirty (90%) patients presented with neurogenic bladder, and 26(78%) with vesico-uretral reflux (VUR). Only 8 patients (group A) received clean intermittent catheterization (CIC), while the rest (group B) were either non-complaint or not on any therapy. Urinary tract infections overall were 4.5 ± 3.8 per year. Patient undergoing CIC had a lower number of UTI (mean per year) 3.3 ± 1.2 vs 6.6 ± 2.3. Sixty two percent of group A had VUR compared with 93% in group B. The mean creatinine was 46 ± 39 µmol/L for the whole group. However, group A had a lower mean creatinine 38 ± 11 compared to 50 ± 34 in group B. In conclusion, early intervention to relieve urinary retention in children born with spina bifida resulted in preserving renal function and less incidence of VUR and UTI. There is a need of more awareness about the importance of starting proactive treatment of risks of upper urinary tract disease and development of renal failure in babies with spina bifida.
  2 4,863 958
Burden among care-givers of kidney transplant recipients and its associated factors
Behzad Einollahi, Saeed Taheri, Eghlim Nemati, Shahin Abbaszadeh, Vahid Pourfarziani, Mohammad Hossein Nourbala
January-February 2009, 20(1):30-34
PMID:19112216
Burden among care-givers of chronically ill patients has been widely investigated. However, there is no study evaluating perceived pressure on care-givers of kidney transplant recipients. This study aimed to evaluate the effect of care-giving to renal transplant recipients in Iranian Muslim population and to analyze factors associated with it. A cross-sectional study was carried out involving 41 care-givers of renal recipients. The Care-giver Burden Scale (CB Scale) was used to evaluate the care-giver's perceived burden and its correlates. Statistical analysis was performed using software SPSS v.13.0. P < 0.05 was considered significant. We found that increased care-giver burden was related to being married (p< 0.02), having lower education level (p< 0.05), and being a parent or spouse to the patient (p< 0.05). We also found significant adverse effects of patients' second transplantation and gender (male) on care-givers' burden. There was no significant relationship between care-giver burden score and patients' marital status, education level, operation time, age, donor type (cadaveric or living), and dialysis history before and after transplantation. In conclusion, care-givers experience strain, which has implications for research and service provision. Service providers need to identify those care-givers at risk of greater strain and help them in situations that cannot be altered. Future research should be conducted to identify the effects of interventions, on care-givers' burden perception.
  2 3,798 740
Evaluating kidney damage from vesico-ureteral reflux in children
M Zaffanello, M Franchini, M Brugnara, V Fanos
January-February 2009, 20(1):57-68
PMID:19112220
To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR), we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000). The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively). However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.
  2 6,512 1,327
Non-cuffed dual lumen catheters in the external jugular veins versus other central veins for hemodialysis patients
Majid Moini, Mohammad R Rasouli, Mohammad Mahmoodzadeh Kenari, Hamid Reza Mahmoodi
January-February 2009, 20(1):44-48
PMID:19112218
To compare prospective between insertion of non-cuffed dual lumen catheter in the external jugular vein and other central veins for hemodialysis (HD), we studied 68 chronic dialysis patients randomly allocated into two groups: one with external jugular vein catheterization as access for HD and another with other central venous catheterization, internal jugular or subclavian vein. Our results showed there were no significant differences regarding successful cannulation, com­plications, total numbers of dialysis, development of pain and infection at the site of cannulation, patency rate of the catheters, and efficacy of hemodialysis between both groups. In addition, the patency of the catheter in the external jugular vein was not affected by previous cannulation of other central veins. In contrast, there was a significant correlation between numbers of attempts for cannulation in both groups and development of hematoma and infection, (p< 0.05). In conclusion, our results showed that the external jugular vein may be an alternative for other central veins for insertion of temporary non-cuffed hemodialysis catheter.
  2 4,049 663
LETTERS TO THE EDITOR
Continuous ambulatory peritoneal dialysis in a patient with scleroderma
Ambar Khaira, Om P Rathi, Sanjay Gupta, Sanjay K Agarwal
January-February 2009, 20(1):130-131
PMID:19112233
  1 2,098 385
Granulomatous interstitial nephritis after prolonged use of phenytoin
Rapur Ram, G Swarnalatha, Neela Prasad, Aruna Prayaga, KV Dakshina Murthy
January-February 2009, 20(1):131-133
PMID:19112234
  1 2,668 501
ORIGINAL ARTICLES
Utility of predicted creatinine clearance using MDRD formula compared with other predictive formulas in Nigerian patients
Sanusi Abubakr Abefe, Arogundade Fatiu Abiola, Akintomide Anthony Olubunmi, Akinsola Adewale
January-February 2009, 20(1):86-90
PMID:19112223
The new predictive formula generated during the study of Modification of Diet in Renal Disease (MDRD) to estimate the glomerular filtration rate in chronic kidney disease (CKD) patients was found to be superior to existing predictive formulas in all races including black Americans. We had previously published a study evaluating and comparing 5 predictive formulas and their applicability in Nigerian CKD patients and normal subjects. The existing data from this study were re-analyzed and the 5 previous formulas compared with the MDRD formula. All the pre­dictive formulas including the MDRD formula correlated significantly with measured creatinine clearance in CKD subjects and controls. Correlation Coefficient, (r) ranged between 0.908-0.968 and Coefficient of Determination, (r 2 ), ranged between 0.826-0.936. There was also good corre­lation between the measured and predicted CrCl in healthy state, though the r and r 2 values were weaker (0.718-0.957) and (0.516-0.916). Specifically, MDRD formula was only superior to Jelliffe and Gates and not so to Cockcroft and Gault, Hull, and Mawer equations in CRF. MDRD formula yielded r= 0.93 and r 2 = 0.86 and the values for Cockcroft and Gault, Hull and Mawer ranged between 0.96-0.97 and 0.93-0.94 respectively. In conclusion, MDRD formula, though useful and applicable was not superior to existing formulas. Cockcroft and Gault equation can still be used due to the ease of recall and its high correlation coefficient in health and disease states.
  1 7,163 631
CASE REPORTS
Early post transplantation renal allograft perfusion failure due to intimal dissection of the renal artery
Omar Salem Khattab, Kais Al-Taee
January-February 2009, 20(1):112-115
PMID:19112228
Transplant renal artery stenosis (TRAS) is a recognized and potentially curable cause of post transplant arterial hypertension, allograft dysfunction, and graft loss. It usually occurs 3 months to 2 years after transplantation, but early or later presentations are not uncommon. We present a case of renal artery narrowing due to intimal dissection that was managed medically.
  - 3,434 437
Minimal change disease versus IgA nephropathy
Wael Latif Jabur
January-February 2009, 20(1):116-119
PMID:19112229
IgA nephropathy is the most common type of the glomerulonephritis all over the world. However, its clinical presentation is variable, as is the underlying histopathological lesion. We report herein a case of an adult with steroid responsive minimal change disease and IgA mesangial deposits. During the first two weeks of therapy with prednisolone, the patient reported dramatic improvement in his clinical condition and remitted his disease. Unfortunately, at the end of the second month of prednisolone therapy, an acute flare of viral hepatitis was diagnosed. Interes­tingly, the acute viral flare was without a concomitant relapse of proteinuria.
  - 3,584 661
Renal cell carcinoma in a child
Mehdi Salehipour, Alireza Rasekhi, Mohammad Vasei, Abbas Hasanpour
January-February 2009, 20(1):124-126
PMID:19112231
Renal cell carcinoma is a rare disease in children and adolescent. Less than 2% of cases occur in childhood and no treatment protocols exist among urologists and oncologists for management. We present a case of renal cell carcinoma in a child with uncommon presentation.
  - 2,464 420
LETTERS TO THE EDITOR
Pulmonary aspergilloma in a patient on hemodialysis
Wael L Jabur, Hareth M Saeed
January-February 2009, 20(1):133-134
PMID:19112235
  - 1,677 327
ORIGINAL ARTICLES
Assessment of the effect of radio contrast media on resistive index of renal artery by color doppler sonography
Ali Shakourirad, Mehdi Ataeefar, Solmaz Jozaghi
January-February 2009, 20(1):91-96
PMID:19112224
Renal ischemia and direct toxic effect of contrast media are the main confounding causes of contrast-induced nephropathy (CIN). The effect of different contrast mediums on the resistance of renal artery is quite unclear. The aim of the present study was to assess the resistive index (RI) changes of renal segmental artery in color Doppler duplex sonography after injection of two different contrast mediums: iodixanol and iohexol. The RI of the renal segmental artery of 62 randomly chosen patients, with a normal baseline renal function, was calculated using color-coded Doppler sonography before and five minutes after bolus injection of two different contrast mediums. Thirty-one patients were administered 50 mL of iodixanol (Visipaque) and 31 patients were admi­nistered 50 mL of iohexol (Omnipaque) during intravenous urogram procedures. The RI results were analyzed and compared in two groups using two-tailed t-test. The mean RI of renal segmental artery increased significantly after administration of contrast media (mean ± SD 0.61 ± 0.046 vs 0.58 ± 0.042; p< 0.001). The mean change of RI was 0.0387 ± .00552 (mean ± SE) in the setting of iohexol injection and 0.0216 ± .00423 (mean ± SE) five minutes after administration of iodixanol (p= 0.017). Both non-ionic iso-osmolar dimeric iodixanol and low-osmolar iohexol increase the renal artery resistance, but the changes are more dramatic with iohexol, suggesting better tolerance with iodixanol.
  - 3,195 626
HLA class I and II antigens expression in patients with renal cell carcinoma
B Cem Ozgur, Faruk Gonenc, Ahmet H Yazicioglu
January-February 2009, 20(1):97-101
PMID:19112225
An optimal antitumoral immune response requires the activation of both CD8(+) and CD4(+) T lymphocytes by the peptide antigen presentation via the human leukocyte antigen (HLA) class I and class II molecules, respectively. The frequency of A1, A26, DR11 alleles are signifi­cantly elevated and seem to be the predisposing alleles in RCC, while HLA A29 and DQ1 are the protective alleles and are found more frequently in the healthy group. To investigate the association between renal cell carcinoma (RCC) and the host's immune system, we immunohistochemically examined RCCs in 44 Turkish patients for the expression of class I and class II antigens. We found a significantly higher frequency of the alleles HLA-A1 (p= 0.001), HLA-A26 (p=0.047) and HLA­DR11 (p= 0.03) in RCC patients compared to the control group. The most frequent alleles in the control population were A29, DQ1 (p= 0.004 and 0.002 respectively). We observed no significant difference between patients and controls in HLA-B and HLA-C allele frequency. We conclude that our study found an association between HLA antigens and RCC in Turkish patients. We found a significantly higher frequency of the alleles HLA-A1, HLA-A26 and HLA-DR11in RCC patients compared to the control group. Larger studies are required to confirm these results.
  - 2,521 426
The influence of maintenance quality of hemodialysis machines on hemodialysis efficiency
Ahmad Taher Azar
January-February 2009, 20(1):49-56
PMID:19112219
Several studies suggest that there is a correlation between dose of dialysis and machine maintenance. However, in spite of the current practice, there are conflicting reports regarding the relationship between dose of dialysis or patient outcome, and machine maintenance. In order to evaluate the impact of hemodialysis machine maintenance on dialysis adequacy Kt/V and session performance, data were processed on 134 patients on 3-times-per-week dialysis regimens by dividing the patients into four groups and also dividing the hemodialysis machines into four groups according to their year of installation. The equilibrated dialysis dose eq Kt/V, urea reduction ratio (URR) and the overall equipment effectiveness (OEE) were calculated in each group to show the effect hemodialysis machine efficiency on the overall session performance. The average working time per machine per month was 270 hours. The cumulative number of hours according to the year of installation was: 26,122 hours for machines installed in 1998; 21,596 hours for machines installed in 1999, 8362 hours for those installed in 2003 and 2486 hours for those installed in 2005. The mean time between failures (MTBF) was 1.8, 2.1, 4.2 and 6 months between failures for machines installed in 1999, 1998, 2003 and 2005, respectively. Statistical analysis demonstrated that the dialysis dose eq Kt/V and URR were increased as the overall equipment effectiveness (OEE) increases with regular maintenance procedures. Maintenance has become one of the most expedient approaches to guarantee high machine dependability. The efficiency of dialysis machine is relevant in assuring a proper dialysis adequacy.
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